Factors Affecting Emergency Medical Technicians’ On-Scene Decision-Making in Emergency Situations: A Qualitative Study

Introduction: To save lives and reduce the disability and death of the patients, emergency medical technicians (EMTs) must make timely decisions in complex and, sometimes, life-threatening situations. Since the pre-hospital decision-making is a continuous and important process. Objective: The present study aims to identify the factors affecting EMTs’ on-scene decision-making in emergency situations. Methods: A qualitative approach using in-depth semi-structured interviews and field observations was employed to explore the factors influencing EMTs’ on-scene decision-making in emergency situations. Purposeful sampling was performed with 19 participants including 12 EMTs, 3 dispatchers, 3 medical directions physicians and one EMS manager as a policy maker. Interviews were conducted from October 2018 to March 2018 and the data were analyzed using Graneheim and Lundman’s content analysis approach. Results: Eight categories and 18 sub-categories emerged to describe the factors effective in emergency medical technicians’ on-scene decision-making. they  were cultural context (community’s culture and organizational culture), interactions (malingering, threat and violence and considerations), competencies (acquisitive and intrinsic); personal feeling (positive feeling and negative feeling), authority (structural and in processing),  education (public and professional), special conditions (patient’s clinical situation, weather conditions, mission’s time and mission’s location), and organizational resource (facility and equipment, and human resources). Conclusions: To facilitate EMTs’ on-scene decision-making, it is recommended to clarify the EMTs’ responsibilities, promote the community’s culture, modify people’s expectations, police monitoring and control and value the star of logo on EMTs' uniform. The EMTs’ on-scene decision-making process should also be explored

Factors Affecting Emergency Medical Technicians’ On-Scene Decision-Making in Emergency Situations: A Qualitative Study

Introduction: To save lives and reduce the disability and death of the patients, emergency medical technicians (EMTs) must make timely decisions in complex and, sometimes, life-threatening situations. Since the pre-hospital decision-making is a continuous and important process. Objective: The present study aims to identify the factors affecting EMTs’ on-scene decision-making in emergency situations. Methods: A qualitative approach using in-depth semi-structured interviews and field observations was employed to explore the factors influencing EMTs’ on-scene decision-making in emergency situations. Purposeful sampling was performed with 19 participants including 12 EMTs, 3 dispatchers, 3 medical directions physicians and one EMS manager as a policy maker. Interviews were conducted from October 2018 to March 2018 and the data were analyzed using Graneheim and Lundman’s content analysis approach. Results: Eight categories and 18 sub-categories emerged to describe the factors effective in emergency medical technicians’ on-scene decision-making. they  were cultural context (community’s culture and organizational culture), interactions (malingering, threat and violence and considerations), competencies (acquisitive and intrinsic); personal feeling (positive feeling and negative feeling), authority (structural and in processing),  education (public and professional), special conditions (patient’s clinical situation, weather conditions, mission’s time and mission’s location), and organizational resource (facility and equipment, and human resources). Conclusions: To facilitate EMTs’ on-scene decision-making, it is recommended to clarify the EMTs’ responsibilities, promote the community’s culture, modify people’s expectations, police monitoring and control and value the star of logo on EMTs' uniform. The EMTs’ on-scene decision-making process should also be explored

Factors influencing pre-hospital care time intervals in Iran: a qualitative study

Abstract: Background: Pre-hospital time management provides better access to victims of road traffic crashes (RTCs) and can help minimize preventable deaths, injuries and disabilities. While most studies have been focused on measuring various time intervals in the pre-hospital phase, to our best knowledge there is no study exploring the barriers and facilitators that affects these various intervals qualitatively. The present study aimed to explore factors affecting various time intervals relating to road traffic incidents in the pre-hospital phase and provides suggestions for improvements in Iran. Methods: The study was conducted during 2013-2014 at both the national and local level in Iran. Overall, 18 face-to-face interviews with emergency medical services (EMS) personnel were used for data collection. Qualitative content analysis was employed to analyze the data. Results: The most important barriers in relation to pre-hospital intervals were related to the manner of cooperation by members of the public with the EMS and their involvement at the crash scene, as well as to pre-hospital system factors, including the number and location of EMS facilities, type and number of ambulances and manpower. These factors usually affect how rapidly the EMS can arrive at the scene of the crash and how quickly victims can be transferred to hospital. These two categories have six main themes: notification interval; activation interval; response interval; on-scene interval; transport interval; and delivery interval. Conclusions: Despite more focus on physical resources, cooperation from members of the public needs to be taken in account in order to achieve better pre-hospital management of the various intervals, possibly through the use of public education campaigns

Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study [version 1; referees: 2 approved]

Background: Infectious diseases are common problems in mass gatherings, especially when there is a lack of health system preparedness. Since Iran is one of the most important countries on the walking path of Arbaeen and has a vital role in providing health services to pilgrims, the experiences of health challenges by participants is of key importance. The aim of this study is to explore stakeholders’ experiences on the health system's preparedness and challenges, and to provide suggestions for preventing infectious diseases during the Arbaeen mass gathering. Methods: A qualitative research method was used with a conventional content analysis approach. The number of participants was 17, including 13 executive managers and 4 health policymakers who entered the study among participants. Semi-structured interviews were used to generate the data. Interviews were analyzed by means of content analysis after face-to-face interviews. Results: Data analysis resulted in the extraction of four main themes and 11 sub-themes. Health infrastructure defects in Iraq has three sub-themes (health abandonment in Iraq, the weaknesses in health culture and problems related to the health system); poor control of the causative factors of infectious diseases has three sub-themes (the underlying factors of the prevalence of contagious diseases, health system response to communicable diseases and ignoring the risks of the Arbaeen ceremony); the low perception of risk in pilgrims has three sub-themes (lack of awareness in pilgrims, fatalism in pilgrims and unhygienic belief in pilgrims); and the ineffectiveness of health education has two sub-themes (training shortage in the targeted group and educational content problems) that shows participant’s experiences of the health system's challenges for coping with infectious diseases during the Arbaeen ceremony. Conclusion: Pilgrim-based training, planning and controlling other challenges may change these threats to opportunities and improve the health of participants of the mass gathering of Arbaeen in the region

Exploring the Factors Affecting Unsafe Antisocial Behaviors of Drivers in Iran: A Qualitative Study

Objective: To explore the factors affecting unsafe antisocial behaviors of drivers in the context of Iran.Methods: The interviews were conducted from June to November 2019. A number of 19 participants were selected using purposive sampling method. The data were collected using face to face in-depth semi-structured interviews. Content analysis using Granheim’s approach was applied for data analysis.Results: Seven categories and 14 sub-categories were extracted from the data. The categories included cultural factors, educational and training factors, laws, imitating, substance abuse, awareness and attitude, and psychological problems.Conclusion: Based on the findings, various cultural, legal, educational, individual and psychological factors affect the unsafe antisocial behavior in driving. Seemingly, such behaviors could increase the chance of death or injury caused by road traffic crashes among the road users and affect social welfare of the citizens and road user’s safety

Epidemiology of Vehicle Fire Fatalities of Road Traffic Injuries in Kerman Province, Iran: A Cross-Sectional Study

BACKGROUND: Vehicle fires are one of the most important causes of fatalities in road traffic injuries (RTIs), but there are no accurate statistics about vehicle fire fatalities (VFFs) due to RTIs in Iran. AIM: This study aimed to investigate the Epidemiology of vehicle fire fatalities (VFFs) due to road traffic injuries (RTIs) in Iran.METHODS: In this cross-sectional study, a researcher-made checklist was used to collect the required data from the files of RTI fatalities in the Kerman Legal Medicine Organization (KLMO), or coroner’s office. All reported victims of vehicle fires in the ten years from 2007 to 2017 were included in the study. The data were analysed using SPSS ver. 18, with p = 0.05 considered as the level of significance. RESULTS: The authors found 124 cases of vehicle fire fatalities in Kerman, with a mean age of 30.45 ± 12.41, of which 50% were in the 25-49 years age group. Most frequently, the victims were Iranian (91.9%), married (66.1%), self-employed (51.6%), and urban dwellers (79.8%), and had died because of burns (91.9%). In 46.8% of cases, the victims were the driver, and in the remaining 53.2%, they were the passenger of the crashed vehicle. Most frequently, vehicle fires occurred on extra-urban roads (90.3%), during spring (35.5 %) or summer (32.3%), due to a vehicle-to-vehicle collision (66.9%), between sedans (69.9%), and at night (63.7%). Most victims died at the scene of the incident (87.9%) and had been transferred to hospital by an ambulance (71%).CONCLUSION: This study indicated that car fires caused the death of young and middle-aged people. The authors suggest the implementation of preventative measures promoting car safety; establishing speed management; establishing laws governing driving, manufacturing and importation of vehicles; construction of safe roads; identifying accident-prone points; installing road warning signs; establishing more roadside stations; ensuring stricter police monitoring; and improving vehicle safety standards and public awareness about the risks of speeding

Survey and Comparison of Prehospital Time Intervals of Emergency Services for Stroke Patients in Arak City in 2017

سابقه و هدف: مطالعات متعدد نشان داده است که وسعت آسيب مغزي به مدت‌زمان کاهش خون‌رساني بستگي دارد. هر دقيقه که سکته مغزي بدون درمان باشد، بيمار در حدود 1.9 ميليون سلول مغزي را از دست مي‌دهد. ازاين‌رو کاهش تأخيرهاي مرتبط با شناسايي، انتقال و تشخيص بيماران سکته مغزي حاد مهم است. مراقبت‌هاي مناسب براي بيماران سکته مغزي توسط کارکنان خدمات فوريت‌هاي پزشکي، کمک بزرگي در شناسايي، ارزيابي و انتقال به‌موقع بيماران مي‌نمايد. بر اين اساس هدف اين مطالعه بررسي وضعيت فواصل زماني پيش بيمارستاني ارائه خدمات اورژانس به بيماران سکته مغزي شهرستان اراک در سال 1396 به تفکيک موقعيت مکاني و متغيرهاي زماني (روزهاي هفته و ساعات شبانه‌روز) بود. روش بررسي: در اين مطالعه توصيفي تحليلي مقطعي، داده‌هاي مربوط به فواصل زماني ارائه خدمات به بيماران سکته مغزي، ثبت‌شده در مرکز فوريت‌هاي پزشکي شهرستان اراک در سال 1396 و همچنين متغيرهاي جنسيت و سن آن‌ها توسط نرم‌افزار SPSS نسخه 21 مورد تجزيه‌وتحليل قرارگرفت. يافته‌ها: در اين مطالعه 56 درصد بيماران را افراد مذکر و 43 درصد را افراد مؤنث تشکيل دادند. بيشترين تعداد بيماران در محدوده سني بالاتر از 76 سال قرار داشتند. ميانگين فواصل زماني فعال‌سازي، پاسخ، حضور درصحنه، انتقال، بازگشت و کل برحسب دقيقه و ثانيه به ترتيب برابر با 2:51، 9:12، 18:11، 18:00، 13:58، 15:56 و 49:17 بود. کوتاه‌ترين فاصله زماني پاسخ در مأموريت‌هاي درون‌شهري، در روزهاي جمعه و در مأموريت‌هاي برون‌شهري در روزهاي پنجشنبه قرار داشته و بر اساس ساعات شبانه‌روز، کوتاه‌ترين فواصل زماني پاسخ در مأموريت‌هاي درون‌شهري و برون‌شهري به ترتيب در ساعات 11:59-6:00 و ساعات 17:59-12:00 قرار داشتند. نتيجه‌گيري: نتايج اين مطالعه نشان مي‌دهد که کارکنان فوريت‌هاي پزشکي در هردو مأموريت‌هاي درون‌شهري و برون‌شهري بيشترين اتلاف وقت را در فاصله زماني حضور درصحنه داشته و همچنين به‌صورت کلي فواصل زماني پيش بيمارستاني در مأموريت‌هاي برون‌شهري از حد استاندارد کشوري طولاني‌تر بوده‌اند. How to cite this article: Khanizade A, Khorasani-Zavareh D, Khodakarim S, Palesh M. Survey and Comparison of Prehospital Time Intervals of Emergency Services for Stroke Patients in Arak City in 2017. J Saf Promot Inj Prev. 2020; 8(2):65-74.Background and Objectives: Numerous studies have shown that the extent of brain injury depends on the duration of blood loss. Every minute a stroke remains untreated, the patient loses about 1.9 million brain cells. It is therefore important to reduce the delays associated with the identification, transmission and diagnosis of acute stroke patients. Appropriate care for stroke patients by emergency medical services staff can be of great help in identifying, evaluating, and timely transferring patients. Therefore, the purpose of this study was to evaluate the pre-hospital time intervals of emergency services for stroke patients in Arak city in 2017 in terms of location and time variables (weekdays and hours of days and nights). Materials and Methods: In this descriptive cross-sectional study, data on time intervals for stroke patients arrived at Arak Medical Emergency Center in 2017, and their gender and age variables were analyzed by software SPSS version 21. Results: In this study, 56% of patients were male and 43% were female. Most patients were over 76 years of age. The mean intervals of activation, response, on-scene, transmission, recovery and total in terms of minutes and seconds were 2:51, 9:12, 18:11, 18:00, 13:58, 15:56, and 49:17, respectively. The shortest response times for in-the city missions were on Fridays and out-of-the city missions on Thursdays, and the shortest response times for in-the city and out-of-the city missions were, at 6:00-11:59 am, and 12:00 -17:59 pm respectively. Conclusion: The results of this study showed that emergency medical personnel both inter and intra city missions had the highest time loss for the on-scene time interval, and also overall pre-hospital time intervals in out of the city missions had exceeded the national standards. How to cite this article: Khanizade A, Khorasani-Zavareh D, Khodakarim S, Palesh M. Survey and Comparison of Prehospital Time Intervals of Emergency Services for Stroke Patients in Arak City in 2017. J Saf Promot Inj Prev. 2020; 8(2):65-74

A system approach on safe emergency evacuation in Subways: A systematic literature review

Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial

Preparedness components of health systems in the Eastern Mediterranean Region for effective responses to dust and sand storms: a systematic review [version 1; peer review: 2 approved]

Background: Dust and Sand Storm (DSS), according to estimates by global reports, will increase dramatically in the Eastern Mediterranean Region (EMR). Numerous health problems caused by DSS will be severely affected regions and vulnerable groups. This study aimed to identify the components of the preparedness of health systems for the DSS phenomenon in EMR. Methods: In this systematic review, the peer-reviewed papers in four electronic databases, including Medline through PubMed, Scopus, ISI Web of Science and the Cochrane library, as well as available grey literature, were searched and selected. The research process was carried out by including papers whose results were related to the potential health effects caused by desert dusts in EMR. Was used the combination of three groups of keywords: the exposure factor, health effects as outcomes, and the countries located in EMR. The focus was on the PRISMA checklist, with no time limitations until December 2017. Finally, through 520 related citations, 30 articles were included. Descriptive and thematic content analyses were evaluated. Results: The preparedness components were divided into three and ten main categories and subcategories, respectively. The three categories covered the areas of DSS hazard identification, planning and policy-making, and risk assessment. Conclusions: Recognition of the health system preparedness factors for DSS in EMR will help policy-makers and managers perform appropriate measures when dealing with this hazard. More studies should be conducted to understand these factors in other parts of the world. Registration: PROSPERO registration number CRD42018093325